Caring for older Americans’ teeth and gums is essential, but Medicare generally doesn’t cover that cost

• As dentistry scholars, we believe Koop also deserves credit for something else.
• Americans who rely on the traditional Medicare program for their health insurance get no help from that program with paying their dental bills aside from some narrow exceptions.
• This group includes some 24 million people over 65 – about half of all the people who rely on Medicare for their health insurance.

‘Medically necessary’ exceptions

• The list of circumstances that would lead patients to be eligible is short.
• Some examples include patients scheduled for organ transplants or who have cancer treatment requiring radiation of their jaws.
• But we believe that dental care is necessary for everyone, especially for older people.

Chew, speak, breathe

• While many working Americans get limited dental coverage through their employers, those benefits are usually limited to as little as $1,000 per year.
• And once they retire, Americans almost always lose even that basic coverage.
• Rich Americans with Medicare coverage are almost three times more likely to receive dental care compared to those with low incomes.

Connected to many serious conditions

• Having diabetes makes you three times as likely to develop gum disease because diabetes compromises the body’s response to inflammation and infection.
• At the same time, treating diabetes patients for gum disease can help control their blood sugar levels.

Chemo can damage your teeth

Many cancer treatments can damage teeth, especially for older adults. As a result, Medicare has started to reimburse for dental bills tied to tooth decay or other oral conditions after they get chemotherapy or radiation treatment.

More than nice to have

• Doctors and dentists are educated separately, and doctors learn very little about dental conditions and treatments when they’re in medical school.
• Most dental electronic health records aren’t linked to medical systems, hindering comprehensive care and delivery of dental care to those in need.
• Medical insurance was designed specifically to cover large, unpredictable expenses, while dental insurance was intended to mainly fund predictable and lower-cost preventive care.

Medicare Advantage plans

• Until Medicare expands coverage to include preventive dental services for everyone, alternative plans such as Medicare Advantage, through which the federal government contracts with private insurers to provide Medicare benefits, serve as a stopgap.
• In 2016, only 21% of beneficiaries in traditional Medicare had purchased a stand-alone dental plan, whereas roughly two-thirds of Medicare Advantage enrollees had at least some dental benefits through their coverage.

Frank Scannapieco is affiliated with The Task Force on Design and Analysis in Oral Health Research, and consults for the Colgate-Palmolive Company. Ira Lamster is a member of the Santa Fe Group. He currently receives consulting fees from Colgate, and research support from the CareQuest Institute.